Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients.

Archya Dasgupta,Catherine Coolens,Fabio Y Moraes,Derek S Tsang,Mark Bernstein,David B Shultz,Paul Kongkham,Andrei Damyanovich,Normand Laperriere,Jayson Co,Barbara-Ann Millar,Robert Heaton,Gelareh Zadeh,Jeff Winter,Monique Van Prooijen,Alejandro Berlin,Tatiana Conrad

doi:10.3390/curroncol28010054

Abstract

Background: The purpose of our study was to characterize clinical features among brain metastasis (BM) patients who were long term survivors (LTS). Methods: We reviewed a registry of BM patients referred to our multidisciplinary BM clinic between 2006 and 2014 and identified 97 who lived ≥ 3 years following BM diagnosis. The clinical and treatment characteristics were obtained from a prospectively maintained database, and additional information was obtained through review of electronic medical records and radiologic images. Survival analyses were performed using the Kaplan-Meier method. Results: Median follow up for LTS was 67 months (range 36–181). Median age was 54 years, 65% had single BM, 39% had stable extracranial disease at the time of BM treatment, and brain was the first site of metastasis in 76%. Targetable mutations were present in 39% of patients and 66% received treatment with targeted-, hormonal-, or immuno-therapy. Brain surgery at the time of diagnosis was performed in 40% and stereotactic radiosurgery (SRS) or whole brain radiotherapy (alone or combination) in 52% and 56%, respectively. Following initial BM treatment, 5-year intracranial disease-free survival was 39%, and the cumulative incidence of symptomatic radio-necrosis was 16%. Five and ten-year overall survival was 72% and 26%, respectively. Conclusion: Most LTS were younger than 60 years old and had a single BM. Many received treatment with surgery or targeted, immune, or hormonal therapy.

Highlights

Brain metastases (BM) affect approximately 30% of cancer patients and are especially common in lung, breast, kidney, gastrointestinal cancers, and melanoma [1,2]
Stereotactic radiosurgery (SRS) for oligometastatic brain metastasis (BM) is the standard of care, in part because it results in lower rates of neuro-cognitive toxicity compared to whole-brain radiotherapy (WBRT) and improved local control, albeit with worse distant brain control [5,6,7]
In 76% of patients, BM was present at the time when metastatic disease was first diagnosed

Summary

Introduction

Brain metastases (BM) affect approximately 30% of cancer patients and are especially common in lung, breast, kidney, gastrointestinal cancers, and melanoma [1,2]. The incidence of BM is increasing, due in part to improved neuroimaging and longer overall survival among cancer patients due to improved systemic therapies [3]. The purpose of our study was to characterize clinical features among brain metastasis (BM) patients who were long term survivors (LTS). Methods: We reviewed a registry of BM patients referred to our multidisciplinary BM clinic between 2006 and 2014 and identified 97 who lived ≥ 3 years following BM diagnosis. Median age was 54 years, 65% had single BM, 39% had stable extracranial disease at the time of BM treatment, and brain was the first site of metastasis in 76%. Following initial BM treatment, 5-year intracranial disease-free survival was 39%, and the cumulative incidence of symptomatic radio-necrosis was 16%. Many received treatment with surgery or targeted, immune, or hormonal therapy

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